COVID-19 demonstrated that large-scale biological and infectious disease incidents are not only major public health challenges, but whole-of-government emergencies requiring integrated planning, logistics, communications, and resilience capabilities. As a result, emergency managers, public health agencies, and healthcare organizations increasingly share risks, missions, and operational dependencies. Amid these evolving dynamics, Cadmus has collaborated with federal, state, and local partners—including Health and Human Services (HHS) Administration for Strategic Preparedness and Response (ASPR), the Department of Homeland Security (DHS), the Federal Emergency Management Agency (FEMA), the Countering Weapons of Mass Destruction (CWMD) office, the Centers for Disease Control and Prevention (CDC) and other departments and agencies at the state and local level—to strengthen health security capabilities that bridge preparedness, response, and long-term resilience.
Public health, security, preparedness, and resilience have changed significantly over the past 10+ years as public health agencies, healthcare providers, and resilience experts re-evaluate their focus areas and consider a more holistic approach.
Broadening Perspectives: Public health has shifted from primarily focusing on infectious disease control to a broader understanding of how health touches every aspect of our lives. Conditions such as heart disease, diabetes, and cancer are becoming more prevalent as the population ages and lifestyle factors change, leading to a greater focus on prevention and management of chronic conditions. Public health now places increased emphasis on the social determinants of health, including factors like housing, education, and income levels that are shown to improve community health outcomes. [1]
Emerging Technologies and Innovation: Use of new technology has also increased with the emergence of digital health. Technologies for biosurveillance, syndromic surveillance, and biodetection have become essential tools for monitoring potential outbreaks. The digitalization of health data has improved surveillance, risk assessment, and decision-making when evaluating population health trends. In the past decade, infectious disease prevention has also advanced dramatically, illustrated by the rapid development and deployment of mRNA-based COVID-19 vaccines. [2]
From Planning to Operations: At the same time, health security has steadily transformed from a primarily planning-focused concept to an operational system shaped by and adapted to real-world, large-scale incidents. Existing health security frameworks were tested and reshaped by the COVID-19 pandemic. COVID-19 highlighted critical vulnerabilities in global and national health security systems including supply chain infrastructure and challenges with international cooperation and data sharing. In addition, the devastating human and economic costs of the pandemic forced health security to the forefront, spurring calls for increased investments in prevention, public health, and resilience programs. For example, the Global Health Security Agenda (GHSA), which originally launched in 2014, increased its focus on helping countries build capacity to prevent, detect, and respond to outbreaks. Additionally, the World Health Organization (WHO) established a new WHO Pandemic Agreement to improve global cooperation, equitable access to vaccines and treatments, and real-time risk monitoring. [3]
Systemic Disruptions: Healthcare organizations and emergency management officials now recognize that large-scale disease outbreaks or biological incidents will disrupt essential health and logistics systems nationwide. Major incidents strain public health infrastructure by reducing the availability of medical care, equipment, and funding, severely impacting healthcare organizations large and small. Patient surges can quickly overwhelm hospitals and healthcare systems, leading to shortages of critical supplies like Personal Protective Equipment (PPE), ventilators, and hospital beds. These cascading challenges disrupt other essential services such as cancer screenings, HIV testing, and routine vaccinations. Underserved populations often bear more severe impacts as inequities in healthcare availability and provision are exposed. [4]
Sustained, Long-Term Response: Emergency management departments and agencies nationwide must rapidly expand their focus to include not only natural disasters or human-caused incidents, but also complex, long-term public health crisis response. This will require emergency managers to assume roles that use different skills and rely on coordination across other agencies at the federal, state, and local levels. A pandemic may persist for an unknown duration, further stressing already limited medical and life-sustaining resources. Local emergency managers may need to assist or lead efforts to establish mass testing sites, distribute PPE, and manage new and complex supply chains. Disease outbreaks disrupt supply chains on a global scale as organizations worldwide vie for the same finite amount of PPE and medical equipment, further compounding the challenge of delivering critical resources. Federal agencies like FEMA may be called on as a primary resource to support long-term public health incident response efforts, pushing the boundaries of the agency’s capacity and mission.
Throughout the pandemic, Cadmus partnered with FEMA, CWMD, and HHS ASPR to understand and address many of these emerging challenges. We supported and evaluated surges in staffing and resources and helped these agencies refine strategies to improve health outcomes for the public. Cadmus monitored some of the earliest airport health screening efforts and provided subject-matter expertise, research, and evaluation of after-action outcomes for HHS ASPR. We also developed a separate after-action report (AAR) for HHS and the CDC to assess the effectiveness of surge support for cruise ship passenger screening operations. Insights from these AARs help federal agencies identify strengths and gaps in their capabilities and inform improvements to public health and health security policies and programs.
The COVID-19 pandemic brought public health, medical care, emergency management, and incident preparedness together in sharp focus. State, local, and federal emergency managers and health and medical partners now find themselves closely aligned in their respective missions and objectives to reduce the spread of infectious diseases and ensure critical medical care, PPE, and resources are available for a long-term incident response. Addressing future pandemics and biological incidents through a health security lens—integrating public health, emergency management, and resilience capabilities—can strengthen health outcomes and improve public safety. The table below summarizes some of these complementary health security capabilities.
| Capability | Public Health | Emergency Management |
|---|---|---|
| Hazard Identification & Risk Assessment | Provide scientific data on health threats (e.g., infectious disease patterns, potential biological risks, population health status, and social vulnerabilities). | Provide all-hazards risk analysis (e.g., assess infrastructure vulnerability to public health incidents, screening, emergency medical care, etc.) and analyze potential impacts. |
| Integrated Planning | Develop clinical and epidemiological plans (e.g., protocols for surveillance, contact tracing, medical countermeasures, mass vaccination, and isolation/quarantine). | Develop operational and logistical plans (e.g., implement the Incident Command System, establish resource coordination centers, and develop public health and medical services plans). |
| Training and Exercise | Provide subject-matter expertise for medical scenarios during drills (e.g., practicing rapid diagnostic testing and dispensing medical supplies). | Design, organize, and lead multi-agency exercises to assess communication and coordination across government and private sector stakeholders. |
| Capacity Building | Focus on increasing medical surge capacity (e.g., staffing, beds, supplies) among healthcare coalitions. | Focus on increasing available logistics capacity (e.g., warehouse/storage, PPE distribution chain, emergency communications, mutual aid agreements). |
Federal agencies such as DHS, HHS, and their state and local partners can continue to strengthen shared health security capabilities in several ways.
Cadmus helps public health and emergency management agencies achieve these health security outcomes. We combine expertise in public health, preparedness, emergency management, and resilience to design and strengthen health security programs. Our experience conducting AARs and supporting continuous improvement efforts enables federal, state, and local public health and emergency management partners to translate lessons learned into concrete changes in policy, planning, and operations. With deep experience in preparedness planning and risk and capability assessments, we help agencies understand health risks and gaps, prioritize investments, and implement best practices that reduce health impacts on the public and improve resilience to future incidents.
Scott Teper (scott.teper@cadmusgroup.com) is a Senior Associate at Cadmus with deep expertise in health security and public health preparedness. Over a 20+ year career, he has led high-profile projects supporting DHS, CDC, HHS, and FEMA.
Amanda Witt (amanda.witt@cadmusgroup.com) is a Principal at Cadmus and leads the Cadmus Homeland Security Line of Business. Over a 25+ year career, she has led projects spanning business continuity, operational planning, disaster response and recovery, and policy and guidance.
[1] Royal Society for Public Health (RSPH), “The Top 10 Public Health Achievements of the 21st Century,” RSPH Insights, August 20, 2025, https://www.rsph.org.uk/insights/the-top-10-public-health-achievements-of-the-21st-century/.
[2] Global Preparedness Monitoring Board (GPMB), “Global Health Security Hangs in the Balance in a Volatile and Uncertain World, Report Emphasizes,” news release, October 13, 2025, https://www.gpmb.org/news/news/item/13-10-2025-global-health-security-hangs-in-the-balance-in-a-volatile-and-uncertain-world-report-emphasizes.
[3] Stuart Garman (2025), Recent Developments and Challenges in Public Health: A Global Perspective; J. Advancements in Medical Innovations and Research, 1(1): DOI: SH-AMIR-RA-0003.
[4] Xu O. Impacts and lessons learned from coronavirus-19 pandemic in the United States: preparing for future public health emergencies. Health Econ Rev. 2025 Oct 3;15(1):77. doi: 10.1186/s13561-025-00675-y. PMID: 41042440; PMCID: PMC12495830.
